Healthcare Provider Details

I. General information

NPI: 1922400522
Provider Name (Legal Business Name): LATANDA SALMEN, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2014
Last Update Date: 09/25/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 W 39TH ST
SIOUX FALLS SD
57105-5732
US

IV. Provider business mailing address

111 W 39TH ST
SIOUX FALLS SD
57105-5732
US

V. Phone/Fax

Practice location:
  • Phone: 605-549-5448
  • Fax: 605-221-0310
Mailing address:
  • Phone: 605-549-5448
  • Fax: 605-221-0310

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number3153
License Number StateSD

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: LATANDA SALMEN
Title or Position: OWNER
Credential: CSWPIP
Phone: 605-549-5448